Surveillance Reasonable for Low-Risk Prostate Cancer

Active surveillance may result in better quality of life than initial treatment

TUESDAY, Nov. 30 (HealthDay News) -- For men with low-risk, localized prostate cancer, active surveillance appears to be an attractive alternative to initial treatment in terms of quality of life, according to research published in the Dec. 1 issue of the Journal of the American Medical Association.

Julia H. Hayes, M.D., of Harvard Medical School in Boston, and colleagues performed decision analysis using a simulation model to either treat hypothetical cohorts of men with newly diagnosed prostate cancer with brachytherapy, intensity-modulated radiation therapy, or radical prostatectomy, or to follow up with active surveillance to weigh the latter against initial treatment in terms of quality-of-life benefits and risks for men with low-risk, localized prostate cancer.

The researchers found that the highest quality-adjusted life expectancy (QALE) was associated with active surveillance (11.07 quality-adjusted life-years [QALYs]), followed in descending order by brachytherapy (10.57 QALYs) and radical prostatectomy (10.23 QALYs). Active surveillance was associated with the highest QALE even when the relative risk of prostate cancer-specific death for initial treatment versus active surveillance was as low as 0.6. QALE gains and optimal strategy, however, were dependent on the individual's preferences for ongoing surveillance or treatment.

"Under a wide range of assumptions, for a 65-year-old man, active surveillance is a reasonable approach to low-risk prostate cancer based on QALE compared with initial treatment. However, individual preferences play a central role in the decision whether to treat or to pursue active surveillance," the authors write.